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Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma
Citations from the Literature etan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic an aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94Vo) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks. respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.
95
GYNECOL. ONCOL.; 29/3 (290-304)/1988/ Although the clinical and pathological features of sarcoma botryoides of the vagina in infancy are well documented in the literature, only occasional cases of a histologically similar tumor of the uterine cervix have been described, mostly as individual case reports. We have reviewed 13 cases sarcoma botryoides of the cervix. The patients range in age from 12 to 26 years, with a mean of 18 years. All presented with vaginal bleeding, ‘something’ protruding from the introitus, or both. On gross examination the tumors were polypoid, smooth, glistening, and focally hemorrhagic. Microscopic examination revealed the presence of a cambium layer and cells showing the features of rhabdomyoblasts in all the cases. Sii of the 13 tumors (45%) contained foci of mature cartilage. All the patients were alive and well 1 to 8 years (average 3.5 years) postoperatively except for one who died of the tumor after 1 year. Although most of the patients had a radical operation, sometimes followed by chemotherapy, three had excellent results after polypectomy or cervicectomy. The findings indicate that, unlike its counterpart in the vagina, which has a poor prognosis, sarcoma botryoides of the cervix in young women has a favorable outlook.
ONCOLOGY Presorgieal prognostic factors in carcinoma of the cervix, stages IB and IIA
O’Brien DM; Carmichael JA Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Queen’s University, Kingston, Ont., Canada AM. J. OBSTET. GYNECOL.; 158/2 (250-254)/1988/ Possible prognostic factors in early stage cervical cancer include patient age, tumor size. cell type, differentiation, and channel invasion. In this study each of these factors was evahtated based only on the findings available before surgery, and the observations are compared with patient survival and incidence of node metastases. One hundred consecutive patients with stage IB or HA cervical cancer treated by primary radical surgery and followed by at least 2 years are reported. Diseasefree survival was 9OVoat 2 years and 85% at 5 years; 19% had node metastases. Of the factors studied, only age >50 years was associated with poor prognosis (p < 0.02 versus age < 50 years). Only large tumor size was associated with increased node metastases (p < 0.001 versus medium and small size). Tumor cell type, differentiation, and channel involvement had no bearing on survival or node metastases. Because older age and large tumors appear to be factors of poor prognosis for surgery, and yet it is not clear that these patients fare better with radiotherapy, we suggest a prospective trial of radiotherapy versus surgery for this group.
Sarcoma botryoides of the uterine cervix in young women: A clinkopnthological study of 13 cases
Daya DA; Scully RE Department of Pathology, Henderson Hamilton, On t. Lg V 1C3, Canada
General Hospital,
Continuous iafusion fluoropyrimidiues as salvage therapy for patients wltb advanced ovarian carcinoma
Goodman HM; Dottino PR; Kredenster D; et a.I Division of Gynecologic Oncology, The Department of Obstetrics, Gynecologv and Reproductive Science, The Mount Sinai School of Medicine, New York, NY 10029, USA GYNECOL. ONCOL.; 29/3 (348-355)/1988/ A major challenge facing those caring for patients with ovarian carcinoma is inducing remission following the failure of first-line treatment. Toward this end, we have examined the efficacy of continuous infusion fluoropyrimidines. During a 2year period, nine patients with recurrent ovarian carcinoma received treatment with continuous infusion S-fluorouracil (5FU) or 5-fluorouracil-deoxyribose as single agents or in combination with other drugs. Eight patients were evaluable, with responses obtained with each treatment regimen. Myelotoxicity was mild, with only 3 episodes of grade 4 toxicity out of 70 total cycles of chemotherapy. Mucositis was moderate to severe, tending to be the dose-limiting adverse effect. Continuous infusion 5-FU in these combinations appears to be active with every acceptable toxicity in heavily pretreated patients.
Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma
Patsner B; Mann WJ; Cohen H; Loesch M Division of Gynecologic Oncologv, Department of Obstetrics and Gynecology, School of Medicine, State University of New York, Stony Brook, NY 11794-8091, USA AM. J. OBSTET. GYNECOL.; 158/2 (399-402)/1988/ Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrird carcinoma before definitive surgical stagInt / Gynecol Obstet 28
96
Citations from the Literature
ing and resection. Fifty-seven of 58 (98%) patients with clinical and surgical Stage I or II disease had normal preoperative serum CA 125 levels. All eight patients with clinically advanced endometrial cancer (International Federation of Gynecology and Obstetrics Stage III or IV) had elevated CA 125 levels before surgery. Twenty of 23 patients (87%) with clinical Stage I or II endometrial cancer who were found to have extrauterine spread of disease during staging laparotomy had elevated preoperative serum CA 125 levels. Thus preoperative CA 125 levels were elevated in 28 of 31 patients (90.3%) with surgically staged endometrial adenocarcinoma with extrauterine disease and may play a useful role in detecting those patients with clinically localized endometrial cancer who have occult extrauterine spread of disease.
Individualization of patients for adjuvnnt chemotherapy after surgienl treatment of cervical cancer Ueki M; Okamura S; Maeda T Department of Obstetrics and Gynaecology, Osaka Medical School, Osaka 569, Japan BR. J. OBSTET. GYNAECOL.; 94/10 (985-990)/1987/ Adjuvant chemotherapy using Tegafur (I-(2-tetra hydrofuryl)-5-fluorouracil) was given to 52 of 216 patients with recurrence risk of cervical cancer after primary surgical treatment, the degree of risk of recurrence having been formulated as a discriminant function by computer analysis of risk factors involved in disease recurrence. Using the formula, we have managed outpatients in three groups-no recurrence and recurrence after, and before 5 years. Under existing circumstances the power of the discriminant function we have achieved is not yet entirely satisfactory although clinically of value in patient management. Oral, long-term adjuvant chemotherapy in risk groups was of value, with a 37.44ro instantaneous recurrence rate and mild side-effects. An instantaneous recurrence rate of 37.4% signifies that the recurrence rate in the group of patients given chemotherapy would be 37.4% if it were 100% in the patients not so treated - an improvement factor of just less than 3.
Radical vulvectomy and ‘sneak’superficial inguinal lymphadenectomy with a single elliptic incision Patsner B; Mann WJ Jr Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,State University of New York at Stony Brook School of Medicine, Stony Brook, NY II 794-8091, USA AM. J. OBSTET. GYNECOL.; 15813 I (464-469)/1988/ With a single elliptic radical vulvectomy incision, resection of the primary tumor and bilateral superficial inguinal lymphadenectomies were performed in 18 patients with invasive squamous cell carcinoma of the vulva. Twelve patients (670/o) had no morbidity from the procedure, while five patients (28%) developed significant would breakdown and one patient (5%) developed a groin hematoma. For select patients with invasive vulvar cancer, this modification of the standard ‘butterfly’ incision offers an acceptable surgical approach to this
Int J Gynecol Obstet 28
disease, allowing removal of the primary lesion and adequate sampling of the groin lymphatics. Results of pathologic examinations allow selection of those patients requiring further therapy.
PSYCHOSOMATICS Childhood sexual abuse and the consequences in adult women Bachmann GA; Moeller TP; Benett J Department of Obstetrics and Gynecology, University of Medicine and Dentistty of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA OBSTET. GYNECOL.; 71/4 (631~642)/1988/ This paper reviews the literature on childhood sexual abuse and its implications for women. It is estimated that at least 15-38% of adults have been sexually abused as children, with figures higher for women than for men. Failure to report abuse is common, and only 20-50% of incidents may come to the attention of authorities. Although childhood sexual abuse is present in all socioeconomic groups, more severe forms of abuse appear to be associated with lower socioeconomic status. After the age of ten, a sharp increase is observed in vaginal intercourse, sexual assaults accompanied by physical violence, and abuse committed by strangers. Although fathers are frequently cited as the primary perpetrators, not all studies support this finding. Other relatives have been reported to account for 20-70% of the sexual abuse occurring within the family. A history of childhood abuse may contribute to sexual problems or multiple chronic complaints in the adult woman. Moreover, some of these women may experience depression, anxiety, and low self-esteem. The gynecologist should use empathetic questioning with all patients regarding abuse, and integrate the patient’s history of abuse with current health care. Physicians who are uncomfortable with this topic or who observe ongoing distress in their patients should refer these women to a mental health practitioner who is familiar with the issues common to women who have experienced childhood sexual abuse.
The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse Harrop-Griffiths J; Katon W; Walker E; et al Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA OBSTET. GYNECOL.; 7114 (589-594)/1988/ Twenty-five women with chronic pelvic pain who had undergone diagnostic laparoscopy and 30 women who had laparoscopic examinations for tubal sterilization or infertility investigation were compared psychologically using structured psychiatric and sexual abuse interviews. Results of the fiberoptic pelvic examination were rates independently using the American Fertility Society classification of endometriosis. Compared with controls, the patients with chronic pelvic pain showed significantly greater prevalence of lifetime major depression, current major depression, lifetime substance abuse, adult sexual dysfunction, and somatization. They were
95
GYNECOL. ONCOL.; 29/3 (290-304)/1988/ Although the clinical and pathological features of sarcoma botryoides of the vagina in infancy are well documented in the literature, only occasional cases of a histologically similar tumor of the uterine cervix have been described, mostly as individual case reports. We have reviewed 13 cases sarcoma botryoides of the cervix. The patients range in age from 12 to 26 years, with a mean of 18 years. All presented with vaginal bleeding, ‘something’ protruding from the introitus, or both. On gross examination the tumors were polypoid, smooth, glistening, and focally hemorrhagic. Microscopic examination revealed the presence of a cambium layer and cells showing the features of rhabdomyoblasts in all the cases. Sii of the 13 tumors (45%) contained foci of mature cartilage. All the patients were alive and well 1 to 8 years (average 3.5 years) postoperatively except for one who died of the tumor after 1 year. Although most of the patients had a radical operation, sometimes followed by chemotherapy, three had excellent results after polypectomy or cervicectomy. The findings indicate that, unlike its counterpart in the vagina, which has a poor prognosis, sarcoma botryoides of the cervix in young women has a favorable outlook.
ONCOLOGY Presorgieal prognostic factors in carcinoma of the cervix, stages IB and IIA
O’Brien DM; Carmichael JA Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Queen’s University, Kingston, Ont., Canada AM. J. OBSTET. GYNECOL.; 158/2 (250-254)/1988/ Possible prognostic factors in early stage cervical cancer include patient age, tumor size. cell type, differentiation, and channel invasion. In this study each of these factors was evahtated based only on the findings available before surgery, and the observations are compared with patient survival and incidence of node metastases. One hundred consecutive patients with stage IB or HA cervical cancer treated by primary radical surgery and followed by at least 2 years are reported. Diseasefree survival was 9OVoat 2 years and 85% at 5 years; 19% had node metastases. Of the factors studied, only age >50 years was associated with poor prognosis (p < 0.02 versus age < 50 years). Only large tumor size was associated with increased node metastases (p < 0.001 versus medium and small size). Tumor cell type, differentiation, and channel involvement had no bearing on survival or node metastases. Because older age and large tumors appear to be factors of poor prognosis for surgery, and yet it is not clear that these patients fare better with radiotherapy, we suggest a prospective trial of radiotherapy versus surgery for this group.
Sarcoma botryoides of the uterine cervix in young women: A clinkopnthological study of 13 cases
Daya DA; Scully RE Department of Pathology, Henderson Hamilton, On t. Lg V 1C3, Canada
General Hospital,
Continuous iafusion fluoropyrimidiues as salvage therapy for patients wltb advanced ovarian carcinoma
Goodman HM; Dottino PR; Kredenster D; et a.I Division of Gynecologic Oncology, The Department of Obstetrics, Gynecologv and Reproductive Science, The Mount Sinai School of Medicine, New York, NY 10029, USA GYNECOL. ONCOL.; 29/3 (348-355)/1988/ A major challenge facing those caring for patients with ovarian carcinoma is inducing remission following the failure of first-line treatment. Toward this end, we have examined the efficacy of continuous infusion fluoropyrimidines. During a 2year period, nine patients with recurrent ovarian carcinoma received treatment with continuous infusion S-fluorouracil (5FU) or 5-fluorouracil-deoxyribose as single agents or in combination with other drugs. Eight patients were evaluable, with responses obtained with each treatment regimen. Myelotoxicity was mild, with only 3 episodes of grade 4 toxicity out of 70 total cycles of chemotherapy. Mucositis was moderate to severe, tending to be the dose-limiting adverse effect. Continuous infusion 5-FU in these combinations appears to be active with every acceptable toxicity in heavily pretreated patients.
Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma
Patsner B; Mann WJ; Cohen H; Loesch M Division of Gynecologic Oncologv, Department of Obstetrics and Gynecology, School of Medicine, State University of New York, Stony Brook, NY 11794-8091, USA AM. J. OBSTET. GYNECOL.; 158/2 (399-402)/1988/ Serum CA 125 levels were measured preoperatively by standard radioimmunometric techniques in 89 patients with primary endometrird carcinoma before definitive surgical stagInt / Gynecol Obstet 28
96
Citations from the Literature
ing and resection. Fifty-seven of 58 (98%) patients with clinical and surgical Stage I or II disease had normal preoperative serum CA 125 levels. All eight patients with clinically advanced endometrial cancer (International Federation of Gynecology and Obstetrics Stage III or IV) had elevated CA 125 levels before surgery. Twenty of 23 patients (87%) with clinical Stage I or II endometrial cancer who were found to have extrauterine spread of disease during staging laparotomy had elevated preoperative serum CA 125 levels. Thus preoperative CA 125 levels were elevated in 28 of 31 patients (90.3%) with surgically staged endometrial adenocarcinoma with extrauterine disease and may play a useful role in detecting those patients with clinically localized endometrial cancer who have occult extrauterine spread of disease.
Individualization of patients for adjuvnnt chemotherapy after surgienl treatment of cervical cancer Ueki M; Okamura S; Maeda T Department of Obstetrics and Gynaecology, Osaka Medical School, Osaka 569, Japan BR. J. OBSTET. GYNAECOL.; 94/10 (985-990)/1987/ Adjuvant chemotherapy using Tegafur (I-(2-tetra hydrofuryl)-5-fluorouracil) was given to 52 of 216 patients with recurrence risk of cervical cancer after primary surgical treatment, the degree of risk of recurrence having been formulated as a discriminant function by computer analysis of risk factors involved in disease recurrence. Using the formula, we have managed outpatients in three groups-no recurrence and recurrence after, and before 5 years. Under existing circumstances the power of the discriminant function we have achieved is not yet entirely satisfactory although clinically of value in patient management. Oral, long-term adjuvant chemotherapy in risk groups was of value, with a 37.44ro instantaneous recurrence rate and mild side-effects. An instantaneous recurrence rate of 37.4% signifies that the recurrence rate in the group of patients given chemotherapy would be 37.4% if it were 100% in the patients not so treated - an improvement factor of just less than 3.
Radical vulvectomy and ‘sneak’superficial inguinal lymphadenectomy with a single elliptic incision Patsner B; Mann WJ Jr Division of Gynecologic Oncology, Department of Obstetrics and Gynecology,State University of New York at Stony Brook School of Medicine, Stony Brook, NY II 794-8091, USA AM. J. OBSTET. GYNECOL.; 15813 I (464-469)/1988/ With a single elliptic radical vulvectomy incision, resection of the primary tumor and bilateral superficial inguinal lymphadenectomies were performed in 18 patients with invasive squamous cell carcinoma of the vulva. Twelve patients (670/o) had no morbidity from the procedure, while five patients (28%) developed significant would breakdown and one patient (5%) developed a groin hematoma. For select patients with invasive vulvar cancer, this modification of the standard ‘butterfly’ incision offers an acceptable surgical approach to this
Int J Gynecol Obstet 28
disease, allowing removal of the primary lesion and adequate sampling of the groin lymphatics. Results of pathologic examinations allow selection of those patients requiring further therapy.
PSYCHOSOMATICS Childhood sexual abuse and the consequences in adult women Bachmann GA; Moeller TP; Benett J Department of Obstetrics and Gynecology, University of Medicine and Dentistty of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA OBSTET. GYNECOL.; 71/4 (631~642)/1988/ This paper reviews the literature on childhood sexual abuse and its implications for women. It is estimated that at least 15-38% of adults have been sexually abused as children, with figures higher for women than for men. Failure to report abuse is common, and only 20-50% of incidents may come to the attention of authorities. Although childhood sexual abuse is present in all socioeconomic groups, more severe forms of abuse appear to be associated with lower socioeconomic status. After the age of ten, a sharp increase is observed in vaginal intercourse, sexual assaults accompanied by physical violence, and abuse committed by strangers. Although fathers are frequently cited as the primary perpetrators, not all studies support this finding. Other relatives have been reported to account for 20-70% of the sexual abuse occurring within the family. A history of childhood abuse may contribute to sexual problems or multiple chronic complaints in the adult woman. Moreover, some of these women may experience depression, anxiety, and low self-esteem. The gynecologist should use empathetic questioning with all patients regarding abuse, and integrate the patient’s history of abuse with current health care. Physicians who are uncomfortable with this topic or who observe ongoing distress in their patients should refer these women to a mental health practitioner who is familiar with the issues common to women who have experienced childhood sexual abuse.
The association between chronic pelvic pain, psychiatric diagnoses, and childhood sexual abuse Harrop-Griffiths J; Katon W; Walker E; et al Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA OBSTET. GYNECOL.; 7114 (589-594)/1988/ Twenty-five women with chronic pelvic pain who had undergone diagnostic laparoscopy and 30 women who had laparoscopic examinations for tubal sterilization or infertility investigation were compared psychologically using structured psychiatric and sexual abuse interviews. Results of the fiberoptic pelvic examination were rates independently using the American Fertility Society classification of endometriosis. Compared with controls, the patients with chronic pelvic pain showed significantly greater prevalence of lifetime major depression, current major depression, lifetime substance abuse, adult sexual dysfunction, and somatization. They were